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  • APTA Working for You: Commercial Payer Updates, July 2019

    The commercial payer world is varied and continually evolving. APTA helps its members by staying on top of changes and bringing the physical therapy profession's voice to the table on a wide range of private payer-related issues. Here's a quick rundown of some of the latest news and APTA activities.

    The results of an APTA survey on administrative burden are in
    APTA highlights the results of a 2018/2019 survey on administrative burden in a new infographic. The survey revealed significant concerns from PTs and PTAs, particularly around the impact excessive requirements are having on clinical outcomes. A summary report on the findings is also in the works.

    The survey and infographic will be the subject of a presentation on administrative burden at the 2019 APTA Insurers' Forum. APTA encourages members to review the infographic and summary (when it's released) and use the resources in discussions with payers and other stakeholders.

    OSHA responds to APTA by affirming the PT's role in first aid
    In response to a meeting with APTA and our subsequent request for clarification, the US Department of Labor Occupational Safety and Health Administration (OSHA) issued a statement affirming that in workplace injury incidents, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART). Details on the clarification, which is good news for physical therapists, can be found in this PT in Motion News story.  

    Use of third-party administrators is growing—and staying on top of the changes will require communication
    APTA continues to track the increased use of third-party administrators to manage the physical therapy benefit as national payers implement systems regionally with the intent to include all states and lines of business over time.

    APTA and its chapters collaborate and coordinate efforts to mitigate adverse patient impacts and provider administrative burden related to utilization management (UM) vendors. At the same time, the association seeks to develop a working relationship with payers and UM vendors to advocate for members when issues arise. Those efforts are strengthened through members' ongoing communication with APTA. Download this step-by-step guide for tips on when and how to report new or significantly changed UM programs.

    APTA's work with eviCore is increasing provider access to information
    Utilization management firm eviCore has made it easier for providers to find provider engagement staff assigned to their geographic area. The list, available as a pdf document on the eviCore website, is among the resources available on the company's "training resources" webpage.

    Front-end claim edits are on the rise
    Front-end edits—when a payer automatically denies a claim with a certain profile, forcing the provider to appeal the denial and provide documentation supporting the appeal—are being implemented by several payers and third-party administrators. For PTs, the most frequent trigger for a front-end edit is the use of the 59 modifier.

    APTA has taken several steps to address this issue, including asking the US Centers for Medicare and Medicaid Services (CMS) to remove edits associated with codes commonly used by PTs, engaging commercial payers in discussions about challenges associated with these edits, and providing resources to providers, including this infographic on use of the 59 modifier. APTA urges providers to consult with the association about appropriate use of the 59 modifier, and to follow through with the appeals process if documentation supports its use. Appeals can make a difference—Aetna has already indicated that if the turnover rate on appeals is high for a particular type of claim, the front-end edit will be removed.

    An APTA-sponsored session at a self-insurers' conference focused on the PT's role in population health
    APTA member Michael Eisenhart, PT, presented an APTA-sponsored session titled “Population Health: How Physical Therapists Can Help Your Employees” at the 2019 National Council of Self Insurers annual conference in June. Eisenhart's presentation showcased the role of physical therapy in the workplace and emphasized its potential for employers who self-insure their workers' compensation programs.

    Workers' Compensation programs are evolving in positive ways
    APTA has observed a greater recognition among workers' compensation (WC) programs that physical medicine not only helps address musculoskeletal issues, it also promotes patient participation in recovery and self-management and reduces the risk of reinjury. While overall injury rates and frequency have been declining, the percent of claims with physical medicine involvement have increased by 13%.

    Ohio is an example of the how this shift is playing out. In 2018, the Ohio Bureau of Workers’ Compensation mandated 60 days of conservative care before the authorization of lumbar fusion surgery. Accordingly, a national WC third-party administrator reported a rise in nonsurgical physical therapy referrals, with an attendant drop in surgical referrals—from 11% in 2017 to 5% in 2018.

    New York is also embracing the value of physical therapy in WC. The New York Workers’ Compensation Bureau (NYWCB) adopted a revised fee schedule in October 2018 that became effective on April 1, 2019. NYWCB increased the relative value units (RVUs) to 18 for evaluations and 15 for reevaluations. The bureau also raised RVUs from 8 to 12 for follow-ups. The net result of this change, plus the fee schedule increase, will result in payment increases. APTA's New York Chapter provides a detailed accounting of the changes.

    APTA, AOTA, and ASHA create a guide to assessing habilitation and rehabilitation benefits
    APTA, together with the American Occupational Therapy Association (AOTA) and American Speech-Language-Hearing Association (ASHA), collaborated to create a guide to assessing habilitation and rehabilitation benefit adequacy that emphasizes transparency, access, and affordability. Available on APTA's Essential Health Benefits webpage, the guide forgoes offering a laundry list of specific benefits in favor of establishing a set of principles that the associations believe lead to appropriate coverage of habilitative and rehabilitative services.

    Anthem's transition to a new UM vendor in 13 states is still on, but delayed
    Anthem Blue Cross-BlueShield is moving ahead with its use of utilization management (UM) vendor AIM Specialty Health in 13 states, but technical issues have delayed implementation.

    Providers who bill Anthem in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin can still expect to be required to use the new vendor in the near future—Anthem says it will update providers toward the end of July on when actual implementation will occur

    In the meantime, APTA urges providers in the impacted states to participate in vendor-sponsored training available through the AIM Rehabilitation Provider Portal. If you experience difficulty enrolling in training or other problems, inform your APTA chapter.

    APTA offers a range of resources for learning more about commercial payment and staying connected: sign up for the Coding, Billing, and Payment online community to join the conversation and share experiences; stay informed by visiting APTA's commercial insurance webpage to access information and download tools including customizable appeals letters; and subscribe to the Payment edition of APTA's Friday Focus newsletter series to receive a monthly compilation of payment-related news and resources. Have questions or want to make your voice heard in local, state, and national advocacy? Email advocacy@apta.org.

    APTA-Backed Bill to Provide Diversity-Based Scholarships, Stipends Introduced in House

    APTA's efforts to create a physical therapy profession as diverse as the society it serves could be getting a significant legislative boost: a new bill introduced in the US House of Representatives seeks to provide $5 million per year in scholarships and stipends aimed at increasing the number of students from underrepresented populations in physical therapy and other allied health education programs.

    Introduced by Reps Bobby Rush (IL) and Cathy McMorris Rogers (WA), the Allied Health Workforce Diversity Act of 2019 would set aside money in the Health Resources and Services Administration specifically for use by accredited education programs in physical therapy, occupational therapy, audiology, and speech-language pathology. Those programs would in turn issue scholarships or stipends to students from underrepresented populations including racial or ethnic minorities and students from disadvantaged backgrounds including economic status and disability. APTA, the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), and the American Academy of Audiology (AAA) were instrumental in crafting language for the bill.

    The legislation falls squarely in line with APTA's strategic plan, which identifies greater provider diversity as necessary to ensure the long-term sustainability of the physical therapy profession.

    "We must build a diverse profession by ensuring there are opportunities that allow for inclusion of all individuals who want to become physical therapists and physical therapist assistants," said APTA President Sharon Dunn, PT, PhD, in a joint news release issued by APTA, AOTA, ASHA, and AAA. "The population we serve is evolving and becoming more diverse. We know that patients who receive care from providers who share their racial and ethnic backgrounds tend to respond better to treatment. That's one reason this legislation is so important, and we applaud the representatives who have introduced it."

    APTA government affairs staff will track the bill's progress and share opportunities for grassroots advocacy. The association will add information to its Legislative Action Center later this week for members to use to support the legislation.

    APTA Survey: PTs Say Administrative Burdens Delay Access, Affect Clinical Outcomes

    Think that administrative burdens are hurting your ability to provide the best possible care? You're not alone: results of a recent APTA survey of physical therapists (PTs) nationwide reveal that nearly 3 in 4 believe that overreaching documentation and administrative mandates negatively affect patient outcomes—and 8 in 10 point to excessive requirements as a contributor to clinician burnout.

    The results are now part of an infographic that helps with the association’s efforts for legislative and policy changes to rein in excessive requirements around areas including prior authorization and claim denial appeals. Among the findings:

    Prior authorization requirements delay care and affect clinical outcomes.

    • Three quarters of respondents said that prior authorization requirements delay access to medically necessary care by 25% or more.
    • 72% of survey participants estimated that they wait at least 3 days for a prior authorization decision from an insurer.
    • Just over 1 in 4 respondents said that the wait time is usually more than a week.
    • Approximately 3 in 4 PTs agreed or strongly agreed that prior authorization requirements negatively impact patients' clinical outcomes.

    Claim denial appeals are time-consuming (and often contradictory).

    • 40% of respondents told APTA that payers who say they don't require prior authorization later deny approximately 25% of claims for lack of prior authorization.
    • 65% of PTs said that it takes more than 30 minutes of staff time to prepare an appeal for 1 claim.
    • When it comes to rates of claim denials, appeals, and final dispensation, respondents estimated that 13% of filed claims are denied; of that 13%, 66% are appealed. And in the end just over half of the appeals—52.34%—are overturned.

    Administrative burden is adding to cost—and burnout.

    • The survey revealed that large percentages of both front desk staff and clinicians spend more than 10 minutes per patient requesting approval for continued visits, ranging from 64.6% of clinicians working with Medicaid fee-for-service beneficiaries, to 77.3% of front desk staff requesting continued visits for Medicaid managed care patients.
    • More than three-quarters of facilities—76.5%—reported that they've had to add nonclinical staff to handle administrative burden.
    • 85.2% of respondents agree or strongly agree that administrative burden contributes to clinician burnout.

    As for what changes would make the most difference, just over half of respondents believe that standardizing documentation requirements would be a big help. Other popular adjustments were elimination of the requirement for the Medicare plan of care signature and recertification (38.8%), standardization of coverage policies across payers (38.1%), unrestricted direct access (36.1%), and standardization of the prior authorization process (36%).

    "APTA has long argued that excessive administrative burden negatively impacts care—what's important about this survey is the consistency of responses and the level of shared perception among PTs who experience this issue every day," said Kara Gainer, APTA director of regulatory affairs. "Administrative burden isn't a nebulous issue for providers—it is a very real barrier to delivering care, with identifiable pain points and very specific areas in need of change."

    The association continues to place the reduction of administrative burdens high on its advocacy list and has again identified the issue as among it 2019-2021 public policy priorities. One recent opportunity: a request for information (RFI) from the US Centers for Medicare and Medicaid Services (CMS) on reducing administrative burden. APTA will provide comments by the August 12 deadline and has made it easy for individual clinicians to submit comments by way of a template letter that can be personalized to suit specific circumstances. APTA is also developing a template letter that can be used by patients and will post a link to it on the association's regulatory "take action" webpage.

    At the same time, a legislative advocacy opportunity emerged in the form of a congressional bill aimed at improving access to health care for older Americans through, among things, reducing administrative burdens on providers. Known as the "Improving Seniors' Timely Access to Care Act of 2019," (H.R. 3107), the bill was introduced into the US House of Representatives by Reps Suzan DelBene (WA), Mike Kelly (PA), Roger Marshall (KS), and Ami Bera (CA). APTA staff will add information to the Legislative Action Center in the coming weeks for members to use to advocate in support of this legislation.

    “Current prior-authorization programs hinder patient access to medically necessary services and must be modified,” said Katy Neas, APTA executive vice president for public affairs. "But this is just 1 element of the wider administrative burden issue, and APTA will continue to advocate for change on multiple fronts."

    OSHA Responds to APTA by Affirming the PT's Role in First Aid

    When it comes to workplace injury, soft tissue massage is considered first aid for recordkeeping purposes, regardless of whether the health professional providing the treatment holds a certification in Active Release Techniques (ART): that's the bottom-line message from the US Department of Labor Occupational Safety and Health Administration (OSHA) in response to APTA’s request for OSHA clarification on the subject. The OSHA response definitively establishes physical therapists (PTs) among the providers able to perform soft tissue interventions that constitute first aid in work settings.

    The OSHA clarification is a response from a February 2019 meeting secured by APTA government affairs staff in partnership with the APTA Academy of Orthopaedic Physical Therapy’s Occupational Health Special Interest Group and the APTA Private Practice Section. It clears up a previously foggy area of agency regulation involving what is and isn't considered "medical treatment beyond first aid" in the workplace—an important distinction for OSHA, as any treatment beyond first aid must be reported as a work-related injury or illness.

    While the regulations state that "using massages" is considered first aid, APTA pointed out that previous OSHA guidance recognizing ART as a soft tissue intervention led some employers to mistakenly believe that only ART-certified individuals could provide “massage.” APTA asked OSHA to confirm in writing that soft tissue management is considered first aid when it is performed by individuals who do not have ART certification—including non-ART-certified PTs.

    OSHA did just that.

    "OSHA considers the treatments listed in…the regulation to be first aid regardless of the professional status of the person providing the treatment," writes Amanda Edens, director of OSHA's Directorate of Technical Support and Emergency Management. "Even when these treatments are provided by a physician or other licensed health care professional, they are still considered first aid for purposes of [the regulation in question]." Edens went on to state, “Accordingly, soft tissue massage is first aid whether or not such treatment is performed by individuals with ART certification.”

    The letter from OSHA also made it clear that the approach to recording soft tissue injuries and illnesses is the same as any other type of injury or illness, meaning that work-related injuries and illnesses "involving muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs" do in fact meet the general recording criteria if they involve medical treatment beyond first aid, days away from work, transfer, or restricted work.

    "Although this may seem like a minor clarification, it's a great win for PTs," said Kara Gainer, APTA director of regulatory affairs. "It's another affirmation that PTs play a valuable role in workplace health and safety, and can be an important part of employer prevention and wellness teams."

    Want more on the potential for PTs to contribute to population health in the workplace? Check out APTA's webpage "The PT's Role in Promoting a Productive and Healthy Workforce."

    From PT in Motion Magazine: The Power of Adaptive Sports

    Adaptive sports are on the move as a popular way for individuals with physical disabilities to reclaim—and, sometimes discover—their love for physical activity. Do physical therapists (PTs) and physical therapist assistants (PTAs) need to catch up?

    In "The Competitive Edge of Adaptive Sports," featured in the June issue of PT in Motion magazine, Associate Editor Eric Ries examines the ways participation in the modified sports has changed the lives of several individuals—some of whom are PTs—who believed their injuries would forever prevent them from taking part in their favorite activities, such as basketball, cycling, and surfing. When they discovered the possibilities available through adaptive sports programs and leagues, a world they thought was closed to them was reopened.

    However, despite the growing prominence of adaptive sports, many feel that PTs and PTAs are behind the curve when it comes to having sufficient experience and understanding to help patients participate in the programs, according to the article.

    "Still in its infancy" is how Katie Lucas, PT, DPT, chair of the APTA Academy of Sports Physical Therapy's Adaptive Sports Special Interest Group, describes the profession's role in adaptive sports to PT in Motion. "There's a lot of room for growth in research and in terms of identifying and taking advantage of all the ways in which adaptive sports fit into physical therapist practice, enhance wellness, and expand opportunities for patients."

    The article plumbs the possible reasons behind the general lack of awareness, with PTs familiar with adaptive sports offering ideas for changes in physical therapy education programs that would familiarize students with the potential value of the programs. Some of those changes could be as simple as merely exposing students to an adaptive sporting event, they say, but the payoff could be significant for patients and providers.

    Maria Thomassie, PT, DPT, can attest to the benefits of understanding adaptive sports. She tells PT in Motion that being involved in adaptive sports has shed light on "how far we've come in creating an accessible world but how much further we have to go," adding that "there are insights to be gained by PTs and PTAs regardless of practice area."

    "The Competitive Edge of Adaptive Sports" is featured in the June issue of PT in Motion magazine and is open to all viewers—pass it along to nonmember colleagues to show them 1 of the benefits of belonging to APTA. Also open to all: "Let Her Roll," a look at how PTs help roller derby athletes compete in the rink.

    Move Forward Radio: Individuals Who Are Transgender Deserve Person-Centered Care – Just Like Everyone Else

    Sometimes the journey toward better health must begin at the beginning—with an actual acknowledgement that there's a problem, and a sense of self-worth strong enough to allow a person reach out for help. Just ask "Greg," a transgender man who endured pelvic pain for years.

    "My body was, for me, this thing that I fed, and got it in a car, and drove places, and it did the work I wanted it to do," Greg said. "Because I spent so much of my life feeling betrayed by it, it was just this thing I didn't want to pay attention to."

    That all changed when he met Hannah Schoonover, PT, DPT.

    Now available on Move Forward Radio: a conversation with Greg and Schoonover, the physical therapist (PT) who helped Greg see his body—and his connection to it—in a new way. The podcast is a must-listen for anyone seeking a better understanding of not just the challenges faced by the transgender population, but the importance of providers honoring the individual stories every patient brings to the clinic.

    The episode, hosted by PT in Motion magazine associate editor Eric Ries, follows Greg's initial reluctance to seek treatment for pelvic pain, his tentative first steps with Schoonover, and, finally, the development of a strong therapeutic alliance that brought relief—and helped Greg embrace a body he once viewed with disdain. Schoonover and Greg talk about the ways in which pelvic floor physical therapy can address pain, but they also discuss the obstacles to care that can arise when providers see patients simply as a collection of symptoms.

    Schoonover believes that health care providers need to understand that trauma plays a particularly powerful role among individuals who are transgender—and that this can deter them from seeking care.

    "Their experience is going to be different," Schoonover tells Ries. "There's going to be more sexual assault, there's going to be more violence, there's going to be more discrimination, more bias." That understanding is at the heart of Schoonover's Washington, DC, clinic, Body Connect and Wellness, which specializes in physical therapy for the transgender community. The clinic's baseline is that "all bodies are good bodies, and we're going to make sure that all bodies feel the way they're supposed to feel," she explains.

    It's a philosophy that has made a difference in Greg's life.

    "I'm feeling more open, I'm feeling more confident in my body," Greg says in the podcast. "We carry around emotional pain and we don't think it affects our bodies, but it does."

    Move Forward Radio is hosted at MoveForwardPT.com, APTA's official consumer information website, and can be streamed online or downloaded as a podcast via iTunes, Google Play, or Spotify.

    5 Ways to Get Up to Speed on Interprofessional Health Care in Education and Practice

    Working across health care disciplines isn't a pipe dream: it's an increasingly important fact of professional life for physical therapists (PTs) and physical therapists assistants (PTAs). And physical therapy education programs are helping future PTs and PTAs respond to this reality by adapting curricula to respond to an increasingly collaborative health care environment.

    In honor of National Interprofessional Health Care month, APTA has refreshed its resources on interprofessional practice and education, offering a range of perspectives on the topic. From research papers to PT in Motion magazine feature articles, there's a little something for everyone.

    Don't know where to start? Here's a basic roadmap for getting yourself familiar with the issue, all drawn from the APTA Interprofessional Education and Collaborative Practice Resources webpage.

    1. Get an understanding of what interprofessionalism takes.
    APTA and many other professional health care organizations anchor their approach to interprofessional education and practice in the core competencies developed by the Interprofessional Education Collaborative (IPEC). IPEC developed a document that clearly lays out 4 main competencies and related sub-competencies that are necessary for success.

    2. Find out how you're doing.
    Understanding the skills needed to be effective in interprofessional behaviors isn't the same thing as actually engaging in those behaviors. This assessment instrument from the Interprofessional Professionalism Collaborative can help you get a clearer view of the extent to which you live out interprofessional values in your day-to-day work.

    3. Keep up with the latest developments.
    The National Academies of Practice (NAP) is a leader in the promotion of interprofessional health care and home to the Journal of Interprofessional Education & Practice. Find out what's happening across disciplines, and visit individual academies member microsites—including 1 for physical therapy.

    4. Dive deeper into physical therapy's role in interprofessional practice.
    The National Interprofessional Education Consortium (NIPEC), sponsored by the American Council of Academic Physical Therapy (ACAPT), is designed as a resource for faculty at ACAPT member institutions; however, NIPEC's website contains plenty of information available to everyone, including assessments, development resources, and webinars—all specifically aimed at how physical therapy integrates with crossdisciplinary collaboration.

    5. Explore how the next generation of PTs and PTAs are being prepared for interprofessionalism.
    Physical therapy education programs are taking creative steps to hone the crossdisciplinary collaboration skills of their students. ThisPT in Motion magazine article describes how PT and PTA students are working with, and benefitting from, students and clinicians from other professions both in the classroom and in their clinical internships.

    Congressional Roundup: What's on APTA's Legislative Advocacy Radar

    Believe it or not, there's much more going on in Washington, DC, than the stuff that becomes fodder for late-night talkshow hosts. Important legislation is being considered, and APTA and its members are there to advocate for changes that help the physical therapy profession's ability to deliver patient-centered care, and improve patient care overall.

    Here's a roundup of recent federal legislative activity on APTA's radar.

    Better coverage for kids under Medicaid is now law.
    On April 18, President Donald Trump signed a law that includes APTA-supported provisions to expand a state option for health homes for children under Medicaid. That particular provision, known as the Advancing Care for Exceptional (ACE) Kids Act of 2019, is included the Medicaid Services Investment and Accountability Act of 2019 signed by Trump.

    The ACE Kids Act addresses existing challenges facing children with medically complex conditions by expanding access to patient-centered, pediatric-focused coordinated care models tailored for these children across multiple providers and services, and by easing access to out-of-state care.

    The legislation builds off of current law to establish specially designed health homes for children with medically complex conditions beginning Oct. 1, 2022. Participation is voluntary for children and their families, providers and states; however, states that opt to create these health homes will receive a higher federal matching rate for 6 months.

    The broader legislative package also provides $20 million for the Money Follows the Person demonstration for fiscal 2019. The demonstration is aimed at transitioning Medicaid beneficiaries from facilities to community-based long-term support services.

    A bill to end the physician self-referral loophole under Medicare is back.
    Reps Jackie Speier (D-CA) and Dina Titus (D-NV) have introduced a bill, known as the Promoting Integrity in Medicare Act (PIMA) of 2019 (HR 2143), that seeks to close Medicare self-referral loopholes for physicians. That loophole allows physicians to refer Medicare patients for physical therapy and other services to a business that has a financial relationship with the referring provider, a gap that has been a target of APTA advocacy efforts for several years.

    The proposed legislation would tighten up self-referral prohibitions under federal law (known as the “Stark Law”) to remove physical therapy, advanced imaging, radiation oncology, and anatomic pathology from the so-called "in-office ancillary services" exception. And it's not without supporters: in addition to APTA's advocacy for the change, previous versions of PIMA have received support from AARP and the Alliance for Integrity in Medicare, a coalition that includes APTA. The 2019 PIMA has been referred to the House Energy and Commerce Committee as well as the Ways and Means Committee.

    Student debt relief options are being considered again.
    It's back: APTA-supported legislation that would list PTs among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    And that's not all—by a long shot.
    APTA's government affairs staff is tracking and speaking out in support of multiple pieces of legislation at various stages of consideration, all of which are consistent with the association's recently adopted public policy priorities.. [Editor's note: want to know how you can get involved in advocacy? Be sure to sign up for APTA’s PTeam, a vital grassroots link to APTA's work on Capitol Hill. All PTeam members receive a quarterly newsletter on legislative activity on Capitol Hill as well as Legislative Action Alerts on federal legislative issues. The alerts let you know when you to contact your members of Congress on particular issues of concern to your patients and the physical therapy profession.]

    These include:

    IDEA Full Funding Act (HR 1878/S 866). This bill would increase spending over the next decade to bring the federal share of funding for special education up to 40%, the amount committed when the law was first enacted in 1975.

    Critical Access Hospital Relief Act of 2019 (HR 1041/S 586). This legislation repeals the 96-hour physician certification requirement for inpatient critical access hospital services under Medicare.

    Lymphedema Treatment Act (HR 1948/S518). The bill provides for the coverage of lymphedema compression treatment items under Medicare.

    Disability Integration Act of 2019 (HR 555/S 117). The proposal would prohibit discrimination against individuals with disabilities who need long-term services and supports.

    Home Health Payment Innovation Act of 2019 (S 433). The bill would require Medicare to implement adjustments to home health reimbursement rates only after behavioral changes by home health agencies that affect Medicare spending actually occur, instead of assuming changes might happen.

    Community and Public Health Programs Extension Act (S 192) This bill provides funding extensions for community health centers and the National Health Service Corps through 2024.

    Improving Access to Medicare Coverage Act of 2019 (HR 1682/S 753). The proposal would define an individual receiving outpatient observation services in a hospital as an inpatient for purposes of satisfying the 3-day inpatient hospital-stay requirement related to Medicare coverage of skilled nursing facility services.

    PHIT Act of 2019 (HR 1679/S 680). The PHIT (Personal Health Investment Today) Act would allow a medical care tax deduction for up to $1,000 ($2,000 for a joint return or a head of household) of qualified sports and fitness expenses per year. The bill defines "qualified sports and fitness expenses" as amounts paid exclusively for the sole purpose of participating in a physical activity, including fitness facility memberships, physical exercise or activity programs, and equipment for a physical exercise or activity program.

    Concussion Awareness and Education Act of 2019 (HR 280). This legislation provides for research and dissemination of information on sports-related and other concussions, and establishes a Concussion Research Commission.

    Mobile Health Record Act of 2019 (HR 1390) This bill requires CMS to establish a program that enables Medicare enrollees to connect claims data with "trusted applications, services, and research programs." The program must allow an enrollee to access claim information through a mobile health record application that is chosen by the enrollee and approved by CMS.

    Geriatrics Workforce Improvement Act (S 299). The proposed law would reauthorize the Geriatric Workforce Enhancement Program (GWEP), which provides grants to geriatric education centers to educate and train health care professionals in the care and treatment of older people. The bill would extend the GWEP for another 5 years, with authorized funding increased to $45 million per year.

    Home Health Care Planning Improvement Act of 2019 (HR 2150/S 296). This proposal would allow Medicare payment for home health services ordered by a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant. Currently, coverage is provided only for services ordered by a physician.

    Rural Hospital Regulatory Relief Act of 2019 (S 895). The bill would create a permanent extension of instructions issued by CMS to not enforce the supervision requirements for therapeutic services provided to outpatients in Critical Access Hospitals and small rural hospitals. Those instructions are set to expire on December 31, 2019.

    Veterans' Access to Child Care Act (HR 840). This bill would provide child care assistance to veterans receiving certain medical services and includes a provision to include Deparmtnet of Veterans Affairs-provided physical therapy for a service-connected disability.

    Protecting Access to Complex Rehab Manual Wheelchairs Act (HR 2293). This proposal would permanently exempt complex rehab manual wheelchairs from the Medicare Competitive Bidding Program and also would stop Medicare from applying competitive bidding payment rates to critical components (accessories) of complex rehab manual wheelchairs for 18 months.

    There's more to come.
    APTA is awaiting introduction of key legislation later this summer that would expand the use of telehealth under Medicare to include physical therapy, and a bill that would add PTs as primary health care providers in community health centers. To receive information and legislative action alerts, sign up for PTeam today and download the APTA Action App on your mobile phone.

    APTA Sheds Light on Upcoming MIPS, Registry Deadlines

    The Merit-based Incentive Payment System (MIPS) is now a professional reality for many physical therapists—as are upcoming deadlines for reporting MIPS data and potentially switching reporting methods. Do you know what you need to do, and when you need to do it? APTA can help.

    Now available from APTA: a detailed annotated list of "MIPS Milestones" and key dates for 2019 and 2020, and a recent #PTTransforms blog post that breaks down options for reporting and how to transition to using APTA's Physical Therapy Outcomes Registry as your MIPS reporting agent.

    In addition to explaining why it's important to be paying attention to MIPS- and Registry-related deadlines—the next of which is coming up June 30—the blog post provides insight into how the Registry works, and includes tips on succeeding in the MIPS environment.

    Student Loan Repayment Program to Include PTs? Health Services Corps Bill Reintroduced in US Senate

    It's back: APTA-supported legislation that would list physical therapists (PTs) among the professions included in a federal program to provide greater patient access to health care in rural and underserved areas has been reintroduced in the Senate. If passed into law, the program could open up access to a student loan repayment program for participating PTs—and help address the nation's opioid crisis in areas that have been especially hard-hit.

    The bill (S.970) would allow PTs to participate in the National Health Service Corps (NHSC) loan repayment program, an initiative that repays up to $50,000 in outstanding student loans to certain health care professionals who agree to work for at least 2 years in a designated Health Professional Shortage Area (HPSA). An estimated 11.4 million Americans are served by the NHSC. The bill was introduced by Sens John Tester (D-MT), Roger Wicker (R-MS), and Angus King (I-ME).

    APTA is a strong supporter of legislation that extends student loan forgiveness to PTs, particularly as a way to improve access to physical therapist services in areas already experiencing shortages. But according to APTA Vice President of Government Affairs Justin Elliott, there's an additional important reason that the association is advocating for the bill's passage.

    "The opioid epidemic has been especially devastating in rural and medically underserved areas," said Elliott. "And while the role of physical therapy as an important nonpharmacological alternative in the prevention, treatment, and management of pain is well-established, the current services corps law doesn't include any physical rehabilitation component. Allowing PTs to participate in the NHSC could help increase patient access to better ways to manage pain, especially for individuals who have or at risk of developing a substance use disorder."

    Advocacy for S.970 (and its yet-to-be-introduced companion in the US House of Representatives) was a major focus of Capitol Hill visits conducted by APTA members as part of the APTA Federal Advocacy Forum held from March 31 to April 2. APTA encourages members to join the push for the bill by contacting their senators to urge them to become cosponsors by way of a prewritten letter, available at the APTA Legislative Action Center, that helps to deliver a unified message (member login required).

    APTA staff will closely track the progress of this legislation—be on the lookout for more opportunities to advocate for this important change.